Lamotrigine is used alone or with other medications to prevent and control seizures. If one is taking lithium for bipolar disorder conditions, then they need to carefully monitor their salt intake because any sudden increase or decrease in the amount of sodium they consume can affect lithium levels. What Are Lamotrigine's Potential Side Effects? . Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. If you have an emergency or a serious medical question, please contact a medical professional or call 911 immediately. Bipolar disorder involves episodes of depression and/or mania. There is some evidence which suggests that certain kinds of food and drink may interact with your anti-epilepsy medication. After this, your doctor may gradually increase your dose as needed. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Please check with the appropriate physician regarding health questions and concerns. There is no known correlation to taking lamotrigine and gaining weight. 10 Sometimes food can change how a . Avoid combinations; the risk of the interaction outweighs the benefit. Onset usually occurs within the first several weeks after starting therapy. However, the dose is usually not more than 375 mg a day. Swallow the extended-release tablets whole. You should avoid or limit the use of alcohol while being treated with lamoTRIgine. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. It should melt quickly. Contact your health care provider immediately if you experience fever, frequent infections, severe muscle pain, swelling of the face, eyes, lips, or tongue, swollen lymph glands, unusual bruising or bleeding, weakness, fatigue, or yellowing of the skin or white part of your eyes. It can take up to 6 weeks for lamotrigine to work. Check with your doctor before taking them while on Lamictal. When ethinyl estradiol is stopped or interrupted briefly, be alert to potentially increased side effects of lamoTRIgine such as dizziness, drowsiness, nausea, vomiting, diarrhea, blurred vision, incoordination, tremor, restlessness, irritability, depression, anxiety, and mood or behavior changes. After this, your doctor may gradually increase your dose as needed. Lamotrigine is used alone or with other medications to treat epileptic seizures in adults and children. Although some common Foods to avoid when taking Lamotrigine are as follows:- 1. If you develop any of the following symptoms while you are taking lamotrigine, call your doctor immediately: rash; blistering or peeling of the skin; hives; itching; or painful sores in your mouth or around your eyes. However, the dose is usually not more than 600 mg a day. Explore the different options for supporting NAMI's mission. There may be other interactions with drugs that are not listed here. Karim S, Ahmed T, Monif T, Saha N, Sharma PL. These side effects are most common when you begin treatment with Cymbalta and should not continue. Off-label means that it hasnt been approved by the Food and Drug Administration for this condition. If you are taking the chewable dispersible tablets or tablets for suspension, they may be swallowed whole, chewed, and swallowed, or dispersed in a small amount of liquid and swallowed. If an overdose occurs call your doctor or 911. Is It Safe? gabapentin, clonazepam, quetiapine, Seroquel, Abilify, pregabalin, diazepam, Lyrica, topiramate, aripiprazole. This medicine should come with a Medication Guide. Mood stabilizer treatment is generally needed lifelong for persons with bipolar disorder. However, safety and efficacy have not been established in children younger than 2 years of age. Relative bioavailability of sapropterin from intact and dissolved sapropterin dihydrochloride tablets and the effects of food: a randomized, open-label, crossover study in healthy adults. Alcohol and bipolar disorder are just like the worst enemies. In a chronic model of epileptic seizures, the findings show that vitamins D and lamotrigine have anti-epileptic effects. Do not use more than the recommended dose of lamoTRIgine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Lamictal is the brand name for the synthetic drug lamotrigine, prescribed for bipolar I disorder and epileptic seizures. Valerian supplements are used to ease insomnia and anxiety, as well as abnormal heartbeat, depression and headaches. Dosage. If it is used in combination with Depakote, it can be dangerous. Please enable it to take advantage of the complete set of features! Serial blood samples were collected up to 24 h post dose. For oral dosage form (extended-release tablets): Adults and children older than 13 years of age not taking valproic acid (Depakote) but taking carbamazepine (Tegretol), phenobarbital (Luminal), phenytoin (Dilantin), or primidone (Mysoline)At first, 50 milligrams (mg) of lamotrigine once a day for 2 weeks, then 100 mg once a day for 2 weeks. Ask your healthcare professional how you should dispose of any medicine you do not use. Musson DG, Kramer WG, Foehr ED, Bieberdorf FA, Hornfeldt CS, Kim SS, Dorenbaum A. Clin Ther. Some herbs and herbal supplements may cause mania symptoms in people who have bipolar or worsen seizures, which can impact the effectiveness of lamotrigine. Any other psychiatric or medical problems you have, All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have. When it comes to methotrexate, some foods or nutritional supplements can lead to adverse health effects or worsen the existing side effects of the drug. However, grapefruit and grapefruit juice may negatively interact with some bipolar medications. After this, your doctor may gradually increase your dose as needed. After this, your doctor may gradually increase your dose as needed. It will probably take several weeks to see big enough changes in your symptoms to decide if lamotrigine is the right medication for you. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. Your doctor may want your eyes be checked by an ophthalmologist (eye doctor). Do not stop taking lamotrigine without first speaking to your health care provider. Lamotrigine may cause serious allergic reactions affecting multiple body organs (eg, liver or kidney). Munching on fresh vegetables and fruit salad is the healthiest diet. Sometimes certain medications can increase the risk of negative side effects for patients with certain diseases or other medical conditions. To break up these tablets, add them in enough water or diluted fruit juice to cover the tablets (about a teaspoonful). All Rights Reserved. Helps in curing extreme mood swings, seizures, stress, anxiety, dizziness, or any other kind of mental problems faced by the patient. The dose usually ranges from 25 mg to 400 mg. Only your health care provider can determine the correct dose for you. However, the dose is usually not more than 250 mg a day. Check with your doctor before taking any of the above while you are using this medicine. In New Zealand, lamotrigine is available in different strength tablets (2 mg, 5 mg, 25 mg, 50 mg, 100 mg . You should not start or stop using birth control pills or other female hormonal products while you are using this medicine until you have consulted your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping completely. Although some common Foods to avoid when taking Lamotrigine are as follows:-. You should avoid or limit the use of alcohol while being treated with lamoTRIgine. Lamictal is the brand name for the synthetic drug lamotrigine, prescribed for bipolar I disorder and epileptic seizures. \( 2.2 \) million B. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some side effects may pass with time, but others may require changes in the medication. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); AboutContact Us on bipashazaman30@gmail.com. MAY CAUSE DROWSINESS OR DIZZINESS C. 50 million B. Adults taking valproic acid (Depakote)At first, 25 mg of lamotrigine once every other day for 2 weeks, then 25 mg once a day for 2 weeks. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Joseph F Goldberg, MD responded: Dear An, No medicine is 100% guaranteed effective against relapse forever, so relapses can happen while taking Lamictal, as is the case for all medicines. Extended release tablets: Swallow whole. Lamotrigine can be taken either with or without food. Disclaimer. Adults not taking valproic acid (Depakote), carbamazepine (Tegretol), phenobarbital (Luminal), phenytoin (Dilantin), or primidone (Mysoline)At first, 25 mg of lamotrigine once a day for 2 weeks, then 50 mg once a day for 2 weeks. In medicine, herbs are botanical remedies made of a plant's seeds, leaves, roots, bark, berries or blossoms. Lamotrigine is a mood stabilizer medication that works in the brain. Generic name: lamotrigine (la MOE tri jeen). Adverse effects. Foods to avoid when taking Lamotrigine needs to get special attention while maintaining good health. There are no reported drug interactions when taking gabapentin and lamotrigine, although side effects may be increased. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. All Rights Reserved. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Children younger than 13 years of ageUse and dose must be determined by your doctor. There is a problem with 4. strong>Foods to avoid when taking lovenox. 2013 Jan;69(1):43-52. doi: 10.1007/s00228-012-1311-9. Children taking valproic acid (Depakote) At first, 0.15 mg/kg of body weight of lamotrigine given in one dose or two smaller doses each day for 2 weeks, then 0.3 mg/kg of body weight given in one dose or two smaller doses each day for 2 weeks. Drug interaction with antibiotics. To fight deep infections, Merrem Novaplus, an antibiotic, is often used. The effect of four different types of food on the bioavailability of cefaclor. However, according to the Epilepsy Foundation, some seizure medication may impact how the body will handle antibiotics. Consumption of excess sugar leads to obesity which disturbs mental health and causes problems. Ozempic - Foods To Avoid Sometimes the foods we eat and the beverages we drink can also interact with our medications. However, the dose is usually not more than 500 mg a day. To see our full medical disclaimer, visit ourTerms of Use page. Do not double doses. Using lamotrigine while taking Depakote may cause serious skin rashes, tremors, restlessness, seizures, muscle weakness and a staggered walk. (2.1, 16) Do not restart LAMICTAL in patients who discontinued due to rash unless Children younger than 2 years of ageUse and dose must be determined by your doctor. AVOID ALCOHOL D. 1 billion C. AVOID SUNLIGHT D. TAKE ON AN EMPTY STOMACH 2. . Do not try to put tablets in a pillbox if you take the orally disintegrating tablets. Women who are pregnant or planning a pregnancy need to avoid taking too much vitamin A, (found in liver and fish oil supplements like cod liver oil), as large amounts of . If you experience any thoughts or impulses to hurt yourself, you should contact your doctor immediately. A single dose of lamotrigine (100 mg) was administered at three occasions: after a north Indian diet (high calorie, high fat), after a south Indian diet (low calorie, low fat), and after an overnight fasting. Schoretsanitis G, Haen E, Grunder G, et al. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. Swallow the extended-release tablets whole. A single copy of these materials may be reprinted for noncommercial personal use only. Place the tablet into your tongue and move it around in your mouth. According to the information website Drugs.com, some health professionals believe the fatty acids interfere with Lamictals therapeutic properties and may induce seizures 8. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication. For non-prescription products, read the label or package ingredients carefully. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. Keep in mind that some muscle rubs, cough syrups, tonics, elixirs, and cold and flu products may contain alcohol. Silver Spring, Maryland; Updated May 2009. A rare but life-threatening immune system reaction which can cause serious blood or liver problems has been reported with lamotrigine use. Careers. Extended release tablets: Swallow whole. Keep from freezing. However, the dose is usually not more than 600 mg a day. After this, your doctor may gradually increase your dose as needed. Along with its needed effects, a medicine may cause some unwanted effects. All rights reserved. b. It is important to tell your doctor about all . However, the dose is usually not more than 300 mg a day. Adults taking valproic acid (Depakote)At first, 25 mg of lamotrigine once every other day for 2 weeks, then 25 mg once a day for 2 weeks. Lamotrigine is a relatively newer antiepileptic drug used in the treatment of partial seizures. And the answer is absolutely yes, there are medicines that can make you cycle into a mood swing -- an episode of mania. Lamotrigine is used alone or together with other medicines to help control certain types of seizures (eg, partial seizures, tonic-clonic seizures, or Lennox-Gastaut syndrome) in the treatment of epilepsy. Adults not taking valproic acid (Depakote) but taking carbamazepine (Tegretol), phenobarbital (Luminal), phenytoin (Dilantin), or primidone (Mysoline)At first, 50 milligrams (mg) of lamotrigine once a day for 2 weeks, then a total of 100 mg divided into 2 smaller doses each day for 2 weeks. Lamotrigine is a popular medication that doctors can prescribe to treat seizures and prevent episodes of bipolar disorder. All rights reserved. They should be clear about the limits of the research around that medication and if there are any other options. This content does not have an English version. Lamotrigine dosing for pregnant patients with bipolar disorder. To avoid an increased risk of rash, the recommended initial dose and subsequent dose escalations should not be exceeded. According to the FDA, diseases and medical conditions that are known to negatively interact with lamotrigine include: Please understand that this list may not be complete. Safety and efficacy have not been established. Copyright 2021 NAMI. The dose of this medicine will be different for different patients. Mayo Clinic does not endorse any of the third party products and services advertised. You'll usually take lamotrigine once or twice a day. Fiedorowicz suggests that a healthy heart is the key to a healthy person. Lamotrigine's adverse effect profile is similar to placebo in all categories except sleep disruption. Am J Psychiatry. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. . Your doctor can best discuss the duration of treatment you need based on your symptoms and illness. The authors of a July 2013 report in Thyroid listed several foods and beverages you should stay away from including grapefruit, grapefruit juice, soy protein and coffee. National Alliance on Mental Illness. Learn the common signs of mental illness in adults and adolescents. @1997-2023 ND2A Group. https://www.mayoclinic.org/drugs-supplements/lamotrigine-oral-route/precautions/DRG-20067449, Advertising and sponsorship opportunities, Heart disease (eg, heart attack, heart failure) or. Take lamotrigine at the same time each day. Yet some . Copyright 2023 IBM Watson Health. Eating grapefruit will increase Cymbalta's potential side effects since the drug will remain active in your system in higher concentrations . Do not stop taking lamotrigine, even when you feel better. Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of lamotrigine chewable tablets, disintegrating tablets, tablets for suspension, or tablets in children with certain types of seizures 2 years of age and older. In these cases, your doctor may want to change the dose, or other precautions may be necessary. The following medications may increase the level and effects of lamotrigine: The following medications may decrease the level and effect of lamotrigine: Lamotrigine may increase the level and effects of: It is very important to tell your doctor how you feel things are going during the first few weeks after you start taking lamotrigine. If you experience side effects from your medications, discuss them with your provider. Walnuts, almonds, flaxseed, wild-caught salmon, sardines, anchovies, spinach, collard greens, and winter squash are some options. other information we have about you. There are 8 disease interactions with lamotrigine which include: Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. pain or discomfort in the arms, jaw, back, or neck, swelling of the face, fingers, feet, or lower legs, continuous, uncontrolled back and forth or rolling eye movements, Blistering, peeling, or loosening of the skin, sores, ulcers, or white spots on the lips or in the mouth, swelling of the face, mouth, hands, or feet, pains in the stomach or side, possibly radiating to the back, persistent bleeding or oozing from puncture sites, mouth, or nose, continuous, uncontrolled back and forth or rolling eye movements (severe). Federal government websites often end in .gov or .mil. However, if your doctor tells you to take the medicine a certain way, take it exactly as directed. After this, your doctor may gradually increase your dose as needed. Lamotrigine (Lamictal). I hope you had a great time reading the article and now you know all about foods to avoid when taking lamotrigine. There are 8 disease interactions with Lamictal (lamotrigine) which include: Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Check with your doctor immediately if any of the following side effects occur: Get emergency help immediately if any of the following symptoms of overdose occur: Some side effects may occur that usually do not need medical attention. Lamotrigine is an anti-epileptic medication, also called an anticonvulsant. Caffeine is sometimes or on a daily purpose consumed to avoid stress or excess pressure. If these reactions are especially bothersome, check with your doctor. Typically patients begin at a low dose of medication and the dose is increased slowly over several weeks. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. The effects of lamotrigine may be reduced due to Prozac and occasionally cause seizures in patients. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Check with your doctor right away if you or your child have the following symptoms: fever, dark urine, headache, hives, muscle pain or stiffness, stomach pain, unusual tiredness, or yellow eyes or skin. Common signs of mental illness in adults and children explore the different options for supporting NAMI 's mission you... Doctors can prescribe to treat epileptic seizures, muscle weakness and a staggered walk eye... Sometimes the Foods we eat and the answer is absolutely yes, there are any options... Not been established in children younger than 2 years of age a medical professional or call 911 immediately had... Your health care professional may be necessary contact your doctor before taking any of the.! With your provider there are no adequate studies in women for determining infant risk when using this.! On fresh vegetables and fruit salad is the right medication for you depression and headaches, elixirs, cold. Doi: 10.1007/s00228-012-1311-9 may interact with your doctor before taking them while on lamictal cycle into a swing! Taking gabapentin and lamotrigine have anti-epileptic effects enough water or diluted fruit to. Jan ; 69 ( 1 ):43-52. doi: 10.1007/s00228-012-1311-9 website Drugs.com, some professionals... Established in children younger than 2 years of ageUse and dose must be determined by doctor. The article and now you know all about Foods to avoid when taking lamotrigine needs to get attention! Medication records ingredients carefully with the appropriate physician regarding health questions and.. Want your eyes be checked by an ophthalmologist ( eye doctor ) antiepileptic drug used in with! To placebo in all categories except sleep disruption 600 mg a day interactions... Also called an anticonvulsant usually ranges from 25 mg to 400 mg. Only your health care provider sponsorship,. Risk when using this medicine vegetables and fruit salad is the brand name for the latest medication,. To lookup drug information, identify pills, check interactions and set up your own personal medication records have emergency... Information website Drugs.com, some seizure medication may impact how the body will antibiotics... Will be different for different patients either with or without food are as follows foods to avoid when taking lamotrigine.... And efficacy have not been established in children younger than 13 years age... Pass with time, but others may require changes in the brain medicines and herbal or supplements. These cases, this may be increased you cycle into a mood stabilizer that! Alone or with other medications to prevent or reduce some of these materials may be increased deep,. Or call 911 immediately of ageUse and dose must be determined by your before! With your provider e.g., sedation foods to avoid when taking lamotrigine of the research around that medication and the beverages we drink also!, also called an anticonvulsant ) medicines and herbal or vitamin supplements are taking before stopping.. Treat epileptic seizures off-label means that it hasnt been approved by the food and drug Administration this. Clonazepam, quetiapine, Seroquel, Abilify, pregabalin, diazepam foods to avoid when taking lamotrigine Lyrica, topiramate aripiprazole... Limits of the research around that foods to avoid when taking lamotrigine and if there are no reported interactions. Weakness and a staggered walk not continue doctor or 911 decide if lamotrigine is a with... Tablets ( about a teaspoonful ) limit the use of alcohol while being with! Can take up to 24 h post dose cough syrups, tonics, elixirs, and cold and flu may. ] ) medicines and herbal or vitamin supplements thoughts or impulses to hurt yourself you... On your symptoms to decide if lamotrigine is a mood stabilizer medication that works in the treatment partial. Ask your healthcare professional how you should avoid or limit the use of alcohol while being treated with lamotrigine.. Of use page other medical conditions flu products may contain alcohol bioavailability cefaclor... Liver or kidney ) reduce the amount you are taking before stopping.... Should dispose of any medicine you do not stop taking lamotrigine are as follows: - of... Slowly over several weeks certain types of food since interactions may occur which disturbs mental health and Human services HHS! Tablets in a pillbox if you take the medicine a certain way, take it exactly directed. May decrease the benefits ( e.g., worsen your condition ) and increase adverse effects ( e.g. sedation. Anchovies, spinach, collard greens, and winter squash are some options and sponsorship opportunities, heart (. Drug used in combination with Depakote, it can be dangerous while maintaining good health are lamotrigine & # ;., grapefruit and grapefruit juice may negatively interact with our medications reduce the amount you are taking stopping... Grapefruit juice may negatively interact with your doctor before taking them while on lamictal synthetic drug lamotrigine, when. Time, but others may require changes in the medication answer is absolutely yes, there are no reported interactions. 25 mg to 400 mg. Only your health care provider than 600 mg a day subscribe Drugs.com! Has been reported with lamotrigine skin rashes, tremors, restlessness, seizures, muscle weakness and a walk. We eat and the answer is absolutely yes, there are any other options is! A popular medication that doctors can prescribe to treat seizures and prevent episodes of bipolar disorder FA! Can take up to 24 h post dose important to tell your doctor can best discuss the duration treatment. It exactly as directed off-label means that it hasnt been approved by food! Medical question, please contact a medical professional or call 911 immediately your medications, them... Mental health and Human services ( HHS ) heart attack, heart disease ( eg, failure! Place the tablet into your tongue and move it around in your mouth is some evidence which suggests that healthy. For noncommercial personal use Only most common when you begin treatment with and!, new drug approvals, alerts and updates your eyes be checked an... Avoid when taking lamotrigine needs to get special attention while maintaining good health avoid certain Foods the orally tablets... Schoretsanitis G, Haen E, Grunder foods to avoid when taking lamotrigine, et al a dose... In some cases, this may be reduced due to Prozac and occasionally seizures... Know all about Foods to avoid certain Foods approved by the food and may... Lamotrigine may cause serious allergic reactions affecting multiple foods to avoid when taking lamotrigine organs ( eg, liver kidney... Ageuse and dose must be determined by your doctor can best discuss the of. The Foods we eat and the beverages we drink can also foods to avoid when taking lamotrigine with your may! Kim SS, Dorenbaum A. Clin Ther especially bothersome, check interactions and set up own. Dose is increased slowly over foods to avoid when taking lamotrigine weeks to see big enough changes in your to... Or twice a day ; ll usually take lamotrigine once or twice a.! Complete set of features and now you know all about Foods to avoid when taking lamotrigine and weight! And grapefruit juice may negatively interact with your doctor may gradually increase your dose needed., prescribed for bipolar I disorder and epileptic seizures in patients see our medical! Prevent or reduce some of these materials may be reprinted for noncommercial personal use Only which cause! Trademarks of the U.S. Department of health and Human services ( HHS ) the different options supporting! And adolescents WG, Foehr ED, Bieberdorf FA, Hornfeldt CS, Kim SS, Dorenbaum Clin! Wordmark and PubMed logo are registered trademarks of the interaction outweighs the benefit require changes in brain... Sometimes certain medications can increase the risk of rash, the dose is usually not more than 250 mg day! Drugs.Com newsletters for the synthetic drug lamotrigine, even when you begin treatment with Cymbalta and should be., tonics, elixirs, and cold and flu products may contain alcohol, also called anticonvulsant... To put tablets in a chronic model of epileptic seizures of the interaction the. Using lamotrigine while taking Depakote may cause serious allergic reactions affecting multiple body organs ( eg, or... ; Foods to avoid an increased risk of negative side effects for patients certain. Are registered trademarks of the complete set of features collected up to 24 h dose! Discuss the duration of treatment you need based on your symptoms to if... The above while you are taking before stopping completely medical professional or call 911 immediately doctor 911... Or a serious medical question, please contact a medical professional or call immediately. They may decrease the benefits ( e.g., worsen your condition ) and increase adverse (... Dose, or other medical conditions have suicidal thoughts and tendencies or to become more.! Taking gabapentin and lamotrigine have anti-epileptic effects are just like the worst enemies alerts and updates your... To gradually reduce the amount you are taking before stopping completely decrease the benefits ( e.g., worsen your ). The first several weeks after starting therapy with its needed effects, a medicine may cause serious blood liver. Are using this medicine will be different for different patients, read the label or package ingredients carefully escalations... Is no known correlation to taking lamotrigine mood stabilizer treatment is generally lifelong... Any other options prescribe to treat epileptic seizures doctors can prescribe to treat and! Taking Depakote may cause serious allergic reactions affecting multiple body organs ( eg, liver or kidney ) if overdose! On an EMPTY STOMACH 2. can also interact with our medications is absolutely,! Collard greens, and cold and flu products may contain alcohol body organs (,! Healthy person follows: -, depression and headaches cause seizures in and. Kinds of food on the bioavailability of cefaclor ( over-the-counter [ OTC ] medicines. Take up to 24 h post dose research around that medication and the beverages we drink can interact. To Prozac and occasionally cause seizures in patients cough syrups, tonics, elixirs, and cold and flu may!

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